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Closing hospitals is not the answer

Changing mindsets and enforcing positive behaviours support can be the most effective remedy to modern functioning hospitals, argues Jonathan Beebee.

Changing mindsets and enforcing positive behaviour support can be the most effective remedy to modern functioning hospitals, argues Jonathan Beebee

The continuing focus on failing hospitals was demonstrated again with Channel 4s Dispatches investigation Under Lock and Key, which featured shocking stories of people at St Andrews Healthcare a large long-stay institution run by the independent sector in Northamptonshire.

The continued focus on hospitals being bad is missing that people who have learning disabilities are abused and mistreated in all settings.

Considering the options

The campaign to close hospitals fails to acknowledge how people ended up in hospital in the first place the decision to admit someone is never taken lightly. People are admitted to hospital because support has failed them

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Changing mindsets and enforcing positive behaviour support can be the most effective remedy to modern functioning hospitals, argues Jonathan Beebee


St Andrew's Hospital, HQ of St Andrew's Healthcare featured in a Dispatches investigation
on Channel 4. Picture: Alamy

The continuing focus on ‘failing hospitals’ was demonstrated again with Channel 4’s Dispatches investigation Under Lock and Key, which featured shocking stories of people at St Andrew’s Healthcare – a large long-stay institution run by the independent sector in Northamptonshire. 

The continued focus on hospitals being bad is missing that people who have learning disabilities are abused and mistreated in all settings. 

Considering the options

The campaign to close hospitals fails to acknowledge how people ended up in hospital in the first place – the decision to admit someone is never taken lightly. People are admitted to hospital because support has failed them where they were previously living. All other options will have been considered. 

If all the hospital beds close, where will people with learning disabilities go? The answer would probably be criminal justice settings or mental health wards, which we know are not suitable places for people who have learning disabilities if they are to be supported effectively. I believe we should apply the principles of positive behaviour support to finding the solution.

Positive behaviour support is often cited as the answer for people who have learning disabilities and challenging behaviour. The key to effective positive behaviour support is a change of mindset. We stop trying to reduce challenging behaviour for people who have learning disabilities, and instead try and understand what the behaviour means. When we understand the meaning we then look to give people better ways of achieving this.

In effect, we try to make the challenging behaviour irrelevant and redundant. Alternatively, if the focus is on reducing challenging behaviour and not meeting function we find one challenging behaviour stops only to be replaced with a new challenging behaviour that may be worse than the original. 

What could happen

We have already seen the side effects of merely trying to close hospitals. Supported living providers are quickly opening 16+ bedded ‘ghettos’ for people with learning disability to be farmed into. 

There is little argument that hospitals are the right place for people who have learning disabilities. However, if we want to stop hospital admissions we should apply the principles of positive behaviour support. We need to understand why people are admitted and then develop more effective solutions.

We need effective community support for people with learning disabilities who are in crisis. We need effective community services to avoid crises in the first place. If there is a better, more effective alternative to hospitals then hospitals will become redundant and irrelevant.

The tragedy is not that people are being cared for in hospitals, it is that there is a need for hospitals in the 21st century.


* Learning Disability Practice online news section included a story on Under Lock and Key: Government urged to tackle abuse of people with learning disabilities in mental health hospitals, which also appeared in our April issue. St Andrew’s Healthcare has refuted the allegations made in the programme as ‘either inaccurate, misleading or taken out of context’. It stated that the safety and well-being of patients is paramount at all times in its treatment.


About the author

 Jonathan Beebee is chief enablement officer and nurse consultant, PBS4 – positive behaviour support social enterprise, Southampton

 

 

 

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